Burns and Lymphedema exam 2 Flashcards
when treating burns, what is our utmost concer?
infections
what source of thermal burns tends to cause full thickness burns?
contact
do direct or alternating current cause more damage?
alternating
will the entry wound or the exit wound of electrical burns have more superficial tissue damage?
exit wound
which layers of skin does first degree frostbite affect?
epidermis
what is the treatment for first degree frostbite?
just re-warming
what layer of skin do second degree frostbite burns affect?
epidermis and dermis
what layer of skin does third degree frostbite affect?
epi, dermis, subq
what layer of skin does fourth degree frostbite affect?
subq and deeper
how long does it take for the acute effects of radiation burns to manifest?
they manifest within 4 weeks
what source of burns makes up the majority of burns in young children?
Scalds (very hot liquid or steam)
what source of burns makes up the majority of burns in the working age adults?
flame
which zone in burn injuries has no tissue perfusion?
zone of coagulation/necrosis
what is the prognosis for the zone of stasis?
chance of tissue recovery if there is optimal management
which zone of burns has a likely chance of tissue recovery?
zone of hyperemia
what percent of TBSA needs to be burnt in order for there to be a systemic response?
20-30%
what are some systemic responses when the body has a complex burn?
hypotension, bronchoconstriction, 3x increase in BMR, reduced immune response
what factors does the Lund and Browder chart compensate for that the rule of nines does not?
age and body shape
what percent of TBSA does a pt’s one palm and fingers make up?
1%
what percent of TBSA would be burned if the entire trunk was burnt (not including the groin or neck)?
36%
what percent of TBSA does a child’s head comprise?
18%
what percent of TBSA does the anterior portion of the left leg of a child comprise?
6.7%
if a wound appears to be pale and pink, what burn type is it likely to be?
superficial dermal
what is the prognosis for superficial epidermal burns? (healing timeline and scars)
7-14 days. No scars
what is the prognosis for superficial dermal burns? (healing timeline and scars)
2-3 weeks. no scars
what is the prognosis for deep dermal burns? (healing timeline and scars)
possibly surgery. possible scarring
what is the prognosis for full thickness burns?
typically requires surgery
what percent of TBSA classifies a burn as non-complex for adults and for children?
less than or equal to 15 and 10
what areas are considered critical in regards to complexity of burns?
hands, feet, face, perineum, genitalia
which type of burns requires management of blisters as part of the treatment?
superficial dermal
what is the next step if during the wound treatment the wound appears to have a local infection?
tx with antimicrobial
what is the next step if during the wound treatment the wound begins to progress to a full thickness burn?
refer to burn unit
when is deroofing blisters advised?
when they are greater than 1 cm
what type of dressing is typically effective in non-complex superficial dermal burns?
non-adhesive contact layer with a secondary absorbent layer
what dressing selection is advised for superficial epidermal burns?
gels or moisture cream
what are the three Rs associated with hypertrophic scarring?
raised, red, rigid
what are risk factors for hypertrophic scarring (there is 6)?
inadequate first aid, poor wound management, infection, position while in hospital, comorbidities, deeper burn depth
what types of burns are at a higher risk for hypertrophic scarring?
deep dermal burns
what are some management techniques for hypertrophic scarring?
massage and moisture; pressure garments; contact media; laser scar therapy, splinting, mobility, functional training.
how can PT help manage hypertrophic scarring?
improving mobility and function. splinting the area to stretch scar tissue and prevent contractures
what special test is there for lymphedema?
stemmer’s sign
what other diseases does pitting edema occur with?
CHF, CVI, and DM
what is stage 1 of lymphedema?
spontaneous and reversible. there is pitting edema and elevation affects swelling
what is stage 2 of lymphedema?
spontaneous and irreversible. No pitting edema and elevation does not help swelling
what is stage 3 of lymphedema?
lymphostatic elephantiasis.
How can one tell the difference between lipedema and lymphedema?
lipedema will be BL, have a - stemmer’s sign, no pitting edema and will mostly occur in younger females
what is class 1 of compression garments and what stages of lymphedema would we use them for?
15-20 mmHg. nurses who stand a lot of mild lymphedema of UE
what is class 2 of compression garments and what stages of lymphedema would we use them for?
20-30 mmHg. Moderate lymphedema of UE, mild in LE
what is class 3 of compression garments and what stages of lymphedema would we use them for?
30-40 mmHg. Severe lymphedema in UE, moderate in LE.
what is class 4 of compression garments and what stages of lymphedema would we use them for?
> 40 mmHg. Severe lymphedema in LE
what signifigance does CKD play in a patient with lymphedema
must be careful performing manual lymph drainage b/c kidneys might not handle the uptake in fluid.
when exercising with a pt who has lymphedema, what precautions should we take/things we should avoid?
repetetive UE movements
